The ME community is well aware
of the long-time involvement of psychiatrist Dr Michael Sharpe with the insurance
company UNUM, of his association with Allied Dunbar and of his recommendation
to insurers that claimants with a diagnosis of ME/CFS should be subject to covert
video surveillance. The ME community will also recall that on 17th
May 1995 Mike Sharpe and Simon Wessely were the main speakers at a UNUM-supported
symposium held in London entitled “Occupational Health Issue for Employers”
(where ME was described as “the malingerers’ charter”) at which they advised
employers how to deal with employees who were on long-term sickness absence
with “CFS”. Moreover, the ME community is hardly likely to forget that in
UNUM’s “Chronic Fatigue Syndrome Management Plan”, ME/CFS is described as “Neurosis
with a new banner” and that same document states “UNUM stands to lose millions
if we do not move quickly to address this increasing problem”. Members of Parliament
are on record as being gravely concerned about the difficulties which their
constituents with ME/CFS suffer at the hands of UNUM, as recorded in the House
of Commons debate chaired by Sir Alan Haselhurst on 21st December
1999 (reference: Hansard 147WH-166WH).

In our “Response to the MRC
Research Advisory Group (RAG) Draft Document for Public Consultation on “CFS/ME”
Research Strategy dated 17th December 2002 – M.Hooper, EP Marshall,
M Williams which can be viewed at http://www.meactionuk.org.uk/Initial_Comments.htm
, we brought to the attention of the MRC what Dr Sharpe states in the UNUM company
Report entitled “Trends in Health and Disability 2002”, including his
confirmation of the involvement of PRISMA in the delivery of cognitive behavioural
therapy for those with “CFS/ME”. It will be recalled that in this UNUM Report,
Dr Sharpe advises that a psychiatric classification provides an alternative
diagnosis of somatoform disorder for patients with “medically unexplained symptoms”
such as CFS and that such a classification has important treatment implications.
Many people are aware that psychiatrist Simon Wessely is a Corporate Officer
(and is ranked higher than the Board of Management, being a member of the Supervisory
Board) of PRISMA, the multi-national commercial healthcare company which in
this UNUM Report Dr Sharpe confirms has already begun funding “rehabilitation”
of UNUM policyholders with programmes of CBT on behalf of the NHS.

Recently there has been much international
publicity about UNUM (one of the largest disability insurers) with the exposition
of their strategy not to pay the valid claims of their policyholders (including
those with ME/CFS). Most vulnerable are policyholders with so-called “subjective
illnesses” like ME/CFS.

In just one case alone (a claim
brought by Dr Joanne Ceimo from Arizona, who was unable to work as a cardiologist
following a neck injury), UNUM faces $84.5 million damages for “mistreating
an injured policy holder”, including $79 million in punitive damages.

In another case, it was revealed
that UNUM had set up a system that appeared to put more emphasis on boosting
company profits than on policyholders’ rightful claims by brushing aside legitimate
claims. It was shown that this was part of a long-running campaign, and a judge
in California (Judge O’Malley Taylor) criticised UNUM, saying

“There is clear and convincing
evidence that (UNUM’s) bad faith was part of a conscious
course of conduct firmly grounded in established company policy”

Steve Dawson, Dr Ceimo’s attorney,
said that evidence from previous policyholder cases against UNUM helped pave
the way for this verdict.

A federal lawsuit filed last year
in New York seeks to represent tens of thousands more UNUM policyholders as
part of a class action against the company, and there have been hundreds of
policyholder lawsuits already against UNUM, with the state of Georgia last month
fining UNUM $1 million over its claims handling practices. The company’s own
former medical director has stated that UNUM’s primary purpose and policy was
to deny disability claims and that company medical advisers were encouraged
to use language in their patient reports that would support claim denials. If
too many medical opinions favoured the policyholder, the doctors would be reprimanded
or sacked.

Last year, a Florida federal court
awarded $36.7 million to opthalmologist John Tedesco when UNUM refused to pay
his benefits after he was diagnosed with Parkinson’s disease.

The case which is probably of most interest
and relevance to the ME/CFS community is that of Dr Judy Morris versus UNUM
(December 2002). Just before filing her lawsuit against UNUM, Dr Morris, an
ME/CFS sufferer who can no longer work in the field of Accident and Emergency
(ER) medicine, attended a conference in Boston and spoke to Dr Mike Sharpe in
person, having found out that it is Sharpe’s research on “CFS” which UNUM uses
to support the view that CFS is a psychiatric condition and upon which UNUM
relies to support the contention that psychotherapy could effectively cure it.
She told Sharpe that his research was being used by UNUM to deny CFS claims.
Later, she received an email from Sharpe telling her that UNUM’s employees were
not the monsters she was making them out to be, whereupon she wrote back asking
him how much UNUM paid him for his “in-service”. He did not reply.

Dr Morris, on her own, obtained
two further opinions from experts about her condition, one of whom (Dr Richard
Glew, an infectious diseases specialist) concluded that Dr Morris certainly
is unable to pursue full-time, high pressure ER work.

The other expert was Professor
Nancy Klimas, an immunologist from the University of Miami in Florida and a
leading researcher in ME/CFS, who tested Dr Morris’ blood, concluding that there
was marked T-cell activation, abnormal CD4 subsets, decreased NK cell function
and markedly increased general immunological activity, and that such results
were “completely consistent with CFS, clinically, historically and immunologically”.

UNUM was sent this objective evidence
and in addition was informed by Dr McIlvaine that the CDC does not consider
CFS a psychiatric problem, but all this was completely ignored by every
defendant at UNUM, who maintained that if she would just have CBT, Dr Morris
“can begin focusing on her many accomplishments rather than on her perceived
failures (and) she will begin the path to recovery and return to work” (Exhibit
#13-6).

Nothing so far related will be
of surprise to the worldwide ME/CFS community. However, both the worldwide ME/CFS
community and the MRC RAG on “CFS/ME” may be particularly surprised at Dr Michael
Sharpe’s evidence in Dr Morris’ legal action. Sharpe, author of the article
relied upon by UNUM, admitted that (quote) “two subsequent controlled trials
found cognitive behaviour therapy to offer no benefit over non-specific management”
(Exhibit #13-12).

Given that the MRC’s RAG draft
document on future research strategies for “CFS/ME” (compiled by Dr Chris Watkins,
whose title is MRC Programme Manager for Research on Mental Illness and Drug
Addiction) states at paragraph 166 that the direction of future management strategy
in the UK should be CBT and graded exercise regimes, and that further research
should “concentrate on the effects of these interventions across the spectrum
of the disorder” (ie. on both the least severe and on the most severe cases),
members of the MRC Research Advisory Group may now, in the light of Dr Sharpe’s
explicit evidence, wish to re-consider their preferred management strategies
for this complex neuro-endocrine-immuno-vascular disorder.

The MRC RAG on “CFS/ME” might also
wish to consider the recent findings of the American Physiological Society that
there is growing evidence in at least a subset of ME/CFS sufferers of reduced
cardiac function, with some sufferers having cardiac disorders that are subtle
enough to escape the current net of clinical cardiological diseases but which
may be significant enough to lead to the clinical syndrome.

Given that research funds are said
to be so limited (though it must not be forgotten that, quite apart from any
recommendations of the MRC RAG, the sum of £2.6 million has passed its first
MRC review and is well on the way to being awarded to psychiatrists Mike Sharpe
(Edinburgh), Simon Wessely (King’s College, London) and Peter White (Bart’s,
London) for a 4 year project looking at the use of CBT and graded exercise
as effective treatment for people with ME/CFS) and particularly in view of the
scathing criticism of the work of the MRC detailed in the recent Report of the
House of Commons Science and Technology Select Committee (reference HC132),
what is the MRC’s explanation for wishing to fund yet more psychosocial research
on “CFS/ME” (an entity which does not officially exist either by definition
or classification) in attempts to “strengthen” the small number of existing
poor-quality studies on the alleged effectiveness of CBT in preference to funding
soundly-based projects on the known biological abnormalities which underpin
this disorder?